Total ankle replacement (TAR) is a surgical procedure that involves replacing a damaged ankle joint with an artificial joint. It is typically performed on patients with severe ankle arthritis or other conditions that have caused damage to the ankle joint. If you are considering TAR, you may have questions about the procedure, the recovery process, and the potential benefits and risks. In this article, we will answer some of the most frequently asked questions about total ankle replacement.

1. How successful is total ankle replacement surgery?

Total ankle replacement surgery has a high success rate, with most patients experiencing significant improvement in their pain and mobility after the procedure. There has been a significant improvement in outcomes over the last decade and the technology and experience with the procedure has progressed rapidly in the recent times.

2. What is the recovery time after the surgery?

The recovery time after surgery can vary depending on the individual patient and the extent of the surgery. In general, patients can expect to be restricted in their weightbearing and in a cast for up to two weeks after the surgery, and then to gradually transition to physical therapy and rehabilitation exercises whilst using a walker boot. It can take several months to fully recover from the procedure and return to normal activities.

3. Who is a good candidate for total ankle replacement?

A good candidate for total ankle replacement is typically someone who has severe ankle arthritis or other damage to the ankle joint that is causing significant pain and mobility issues. Candidates for the procedure should have healthy bones and good circulation, and should not be significantly overweight. It is also important to have realistic expectations about the procedure and to be committed to the recovery process. Those with uncontrolled diabetes who may have nerve damage and those you have an active infection are also excluded.

4. What are the risks and complications of this type of surgery?

As with any surgical procedure, there are risks and potential complications associated with total ankle replacement. These can include infection, blood clots, nerve damage, and problems with the artificial joint such as loosening or wear over time. Your surgeon will discuss these risks with you before the procedure and help you understand what you can do to minimize your risk of complications. You can also read more about the surgery and any potential complications on this site.

5. How long does a total ankle replacement last?

Ankle replacements can last for many years, but they are not necessarily considered a permanent solution. The lifespan of an artificial joint can vary depending on factors such as the patient’s age, weight, activity level, and the extent of their arthritis. Some patients may need to have their ankle replacement revised or replaced after several years, while others may enjoy many years of pain-free mobility. Recent analysis of the data suggests an average of 1-1.5% of implants may fail each year post implantation. As such 85-90% of implants are likely to be in place after 10 years.

6. How much does total ankle replacement surgery cost?

The cost of surgery can vary depending on factors such as the geographic location, the surgeon’s fees, and the extent of the surgery. In the United States, the cost can range from $20,000 to $40,000 or more, depending on the specific circumstances. In the UK, the cost of total ankle replacement surgery is generally covered by the National Health Service (NHS), however to fund this outside of the health services the costs could range from £12,000 to £18,000 depending on the surgeon and the facility performing the surgery.

7. How is total ankle replacement surgery performed?

This surgery is typically performed under general anaesthesia, and involves making an incision at the front of the ankle to access the joint. The damaged joint is then removed and replaced with an artificial joint made of metal and plastic. The surgeon may use screws or other hardware to secure the new joint in place. The incision is then closed and the patient is monitored for any potential complications. I use the Infinity total ankle replacement and the Prophecy pre-operative navigation system which produces patient specific guides. This ensures that the implant is best positioned and sized to fit the particular anatomy exactly on the basis of pre-operative CT scans. You can watch the animation of the surgical process here.

8. What kind of rehabilitation is required after total ankle replacement surgery?

Physiotherapy and rehabilitation exercises are an important part of the recovery process after total ankle replacement surgery. Patients may work with a therapist to learn exercises to improve their range of motion, strength, and balance. They may also use special equipment such as crutches or a walking boot to help support the ankle as it heals. The specific type and duration of physical therapy will vary depending on the patient’s individual needs and the extent of their surgery. The aim is to improve the range of motion and strengthen the muscles around the lower leg.

9. When can I return to normal activities after total ankle replacement surgery?

The timeline for returning to normal activities after total ankle replacement surgery can vary depending on the individual patient and the extent of the surgery. In general, patients should avoid putting weight on the ankle for the first two weeks after the surgery, and should gradually increase their activity level as directed by their surgeon and physical therapist. It may take several months to a year to fully return to higher impact activities. Low impact exercise such as cycling, walking, golf and swimming can commence by 6 months post surgery. High impact sports are not recommended if you have a total ankle prosthesis although a social game of tennis or a brisk hike is often tolerated.

10. How does total ankle replacement compare to ankle fusion surgery?

Ankle fusion surgery is an alternative to replacement for patients with severe ankle arthritis or other damage to the ankle joint. Ankle fusion involves fusing the bones of the ankle joint together, which can eliminate the pain but also limit mobility. A replacement preserves more of the natural movement of the ankle joint, but may not be suitable for all patients depending on their individual circumstances. Your surgeon can help you decide which option is best for you based on your specific needs and goals.